Tooth Colour and Facial Attractiveness: Study Protocol for Self-Perception with a Gender-Based Approach

(1) Background. The aim of the present protocol is to assess whether self-perception of tooth colour and facial attractiveness correlates with gender and mood state. (2) Study protocol. The protocol foresees a cross-sectional clinical study, developed by Sapienza University of Rome, Italy, Department of Oral and MaxilloFacial Sciences, and 15 UNID (Unione Nazionale Igienisti Dentali-National Union of Dental Hygienists)-affiliated clinical centers in Italy. The protocol consists of a clinical visit, during which photographic documentation of the face and smile is collected with spectrophotometric evaluation of tooth colour. During the visit, two validated questionnaires are filled in. The first one is filled by the operator for the collection of data on: i) patient's face and smile colorimetric characteristics; ii) patient's and operator's evaluations of the dental colour and smile attractiveness. The second one is completed by the patient for the assessment of his/her mood state. (3) Conclusions. This protocol highlights the importance in aesthetic dentistry of a gender-specific approach and the limitations of gender-neutral models, revealing the existing gender differences in aesthetic self-perception. In addition, the colour-matching relationships between facial and dental colour characteristics will be explored. This approach improves the accuracy and personalization of aesthetic assessments in dentistry, by addressing personalized and gender-specific needs. A gender-inclusive methodology that takes a more nuanced and culturally aware approach to aesthetic dentistry is a useful adjunct to modern clinical practices.

Blended intensive programme's implementation in dental education: post-pandemic evolution of learning

Blended Intensive Programmes (BIP's) represent a valuable tool for gathering knowledge and summarising the latest trends in medicine and dentistry. Blended education has been found, even before the COVID-19 pandemic, to increase the level of education and stimulate effective learning for postgraduate healthcare professionals. Interprofessional education is critical for preparing students to enter the health workforce, where teamwork and collaboration are important competencies. This article outlines the key points of the Blended Intensive Programme's implementation in dental education organised by Wroclaw Medical University in Poland. BIP involved professors from 12 universities or research institutions from Europe and South America and 28 participants from 8 countries. The course was taught remotely and in person. In addition, it included a visit to the university and practical classes with artificial simulation and practice in dentistry. A structured questionnaire enabled measuring the evaluation of students' perception of the COVID-19 education before and after the pandemic. The European Region Action Scheme for the Mobility of University Students (ERASMUS) was fundamental to carrying out the BIP with the participation of several countries, allowing the exchange of knowledge, assessing the impact of the pandemic on dental universities, and strengthening international collaborations and the future project of research, education and clinical assistance. We conclude that hybrid teaching programmes broaden the learning spectrum in dental studies by allowing transnational and interdisciplinary approaches that make students aware of the importance of their work within the framework of the general health approach, as this differs from country to country.

Orthodontic treatment demand for fixed treatment and aligners among young adults in middle Europe and South America - a questionnaire study

BACKGROUND

Patients experiencing any malocclusion, may desire for treatment. However, there is no scientific information orthodontic treatment demand and the knowledge of young adults about orthodontic treatment. The aim of the study was to assess orthodontic treatment demand in young adults from Poland and Chile, their previous orthodontic experience and their knowledge on fixed and aligner orthodontic treatment.

METHODS

The target group comprised people aged 18-30. The sample size was estimated as above 400 for each country. The survey was carried out in Polish and Spanish within 3 months and consisted of 25 questions delivered via social media. Comparisons were made between countries, age subgroups and gender.

RESULTS

The response rate was 1,99%, what stands for 1092 responses, 670 from Chile and 422 from Poland, respectively. The percentage of young adults who were already treated was 42,9% in Poland and 25,0% in Chile. The ones planning to have orthodontic treatment within a year counted for 11,8% in Poland and 5,3% in Chile. Most young adults who want to be treated (20,6%) rely on doctor's recommendation on type of appliance while 14,7% of all respondents are interested solely in aligners. Most respondents have heard about aligners (58%). Direct provider-to-customer service without a doctor is not acceptable, neither in Poland (85,1%) nor in Chile (64,8%). Most young adults provided incorrect answers referring various aspects of aligner treatment.

CONCLUSIONS

In both countries, patients demand to be treated and monitored by the orthodontist. A high percentage of patients want to be treated exclusively with aligners. Direct-to-consumer orthodontics does not seem attractive to patients. Young adults do not have adequate knowledge referring to aligner treatment. Many people want to be treated despite a previous orthodontic treatment.

Use of del Nido cardioplegia in acute coronary syndrome cases with decreased ejection fraction

BACKGROUND

There has been increasing interest in using del Nido cardioplegia in adult cardiac surgery. However, there is limited evidence for its efficacy in patients with acute coronary syndrome and reduced ejection fraction.

METHODS

This study examined patients with decreased ejection fraction (EF < 40%) who were hospitalized due to acute coronary syndrome and received either del Nido (DN) or cold blood cardioplegia (CB). The patients were matched based on age, gender, myocardial infarction at baseline, and number of conducted surgical procedures. An analysis was conducted on postoperative biomarker release (high-sensitivity troponin T and isoenzyme creatine kinase-MB (CK-MB)), changes in myocardial contractility and perioperative outcomes.

RESULTS

62 pairs of patients with similar baseline characteristics were selected. 51.6% of pairs underwent isolated coronary artery bypass grafting, while 48.4% underwent a complex procedure. Postoperative troponin values did not differ significantly at 12 h (median (IQR): 606.7 (381.4-974.8) pg/mL vs. 552 (231.8-1579.5) pg/mL; p = 0.913), nor did CK-MB (median (IQR): 24.3 (12.6-45.5) ng/mL vs. 23.7 (12.3-49.8) ng/mL; p = 0.972). The postoperative EF was similar between groups (median (IQR): 30% (30-35%) vs. 34% (30-38%); p = 0.323). No difference in perioperative mortality, myocardial infarction, stroke, or composite endpoint was noted. In a multivariate analysis, the cardioplegia protocol did not affect biomarker release or changes in ejection fraction. The first stage of acute kidney injury was more frequent in the CB group (28.5% vs. 9.7%, p = 0.033).

CONCLUSIONS

Both del Nido and cold blood cardioplegia provide adequate cardioprotection in patients with acute coronary syndrome with decreased ejection fraction.

Comparison of efficacy of pharmacological cardioversion with antazoline and propafenone versus electrical cardioversion in atrial fibrillation during cryoablation

Introduction

Antazoline with propafenone may be an alternative to electrical cardioversion (ECV) in restoring sinus rhythm in patients with atrial fibrillation (AF), including during balloon cryoablation.

Aim

To compare the efficacy of antazoline with propafenone and ECV in restoring and maintaining sinus rhythm at discharge in patients with AF during cryoablation with special regard to type of AF.

Material and methods

The study retrospectively analyzed 196 patients who underwent elective cryoablation. Eighty-nine patients who developed AF in the perioperative period were selected as the study group (32 women and 57 men). The study group was divided into two groups - 46 (51.7%) patients were given pharmacological cardioversion with 70 mg of propafenone and 100 or 200 mg of antazoline, whereas the other 43 (48.3%) patients underwent ECV.

Results

There were no statistically significant differences between the groups regarding: left atrial area, left atrium diameter, right atrial area and right atrium diameter. In the overall population, ECV was more effective than antazoline with propafenone therapy (31 [72.1%] vs. 20 [43.5%]; p = 0.01). A similar relationship was demonstrated in patients with persistent AF (13 [59.1%] vs. 3 [12.5%]; p = 0.002). There was no significant difference in the group of patients with paroxysmal AF (18 (85.6%) vs. 17 (77.3%); p = 0.7).

Conclusions

In AF during the cryoablation procedure ECV appears to be more effective in restoring and maintaining sinus rhythm at discharge than antazoline with propafenone in the general AF patient population, especially in patients with persistent AF.

Del Nido vs. Cold Blood Cardioplegia for High-Risk Isolated Coronary Artery Bypass Grafting in Patients with Reduced Ventricular Function

INTRODUCTION

The evidence for using del Nido cardioplegia protocol in high-risk patients with reduced ejection fraction undergoing isolated coronary surgery is insufficient.

METHODS

The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed.

RESULTS

Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051).

CONCLUSION

The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required.

Fixed appliances orthodontic therapy as a risk factor for caries development: Systematic review

Orthodontic treatment is often mandatory to improve the patient's health condition. However, the fixed appliance can create additional plaque retention areas, which can increase the risk of caries development. Clinically, one can observe various effects of fixed appliance treatment on caries prevalence. This study aims to analyze to what extent orthodontic therapy with fixed appliances is a risk factor for developing caries in pediatric and adult patients. The keywords used in the search strategy were as follows: ("caries" AND "caries risk" AND "caries experience" AND" "orthodontic treatment" OR "fixed appliance" ") and ("caries experience" AND "orthodontic treatment").From 808 potential articles, 15 were included in the review. In individuals undergoing fixed orthodontic therapy, several factors can increase the risk of car-ies during fixed orthodontic treatment, such as salivary composition, oral dysbiosis and plaque accumulation. On the other hand, factors that reduce caries risk are, i.e., oral hygiene self-awareness and previous orthodontic treatment. In most studies which used the Decayed, Missing, and Filled Teeth (DMFT) index, there were no significant differences between the values obtained before orthodontic treatment and after the treatment. Moreover, it is easier for a patient with aligned teeth to remove plaque.In the young population, fixed orthodontic treatment appears to reduce the incidence of caries. In the adult population, fixed orthodontic treatment increases the risk of dental caries. However, education on proper oral hygiene during orthodontic treatment can reduce the risk of dental caries. The study protocol was registered in the PROSPERO database [PROSPERO CRD42022356628].

Determinants of Inadequate Cardioprotection in Adult Patients with Left Ventricular Dysfunction

BACKGROUND

 Perioperative cardioprotection is essential for achieving satisfactory clinical outcomes in heart failure patients. It is important to understand the factors affecting perioperative cardioprotection.

METHODS

 The institutional database was searched for patients with reduced ejection fraction (EF, < 40%) who underwent surgery with cardioplegia-induced arrest. Patients were divided into del Nido cardioplegia (DN) and cold blood cardioplegia (CB) groups. The relationships between age, preoperative blood parameters, creatinine, cross-clamp time (CCT), extracorporeal circulation time (ECT), and postoperative troponin values at 12 hours or deterioration of EF (≥5%) were evaluated. Baseline characteristics, operative parameters, and outcomes were analyzed.

RESULTS

 There were 508 patients with reduced EF (331 DN and 177 CB). In the entire cohort, anemic patients had greater troponin values (p = 0.004) as well as in the DN group (p = 0.002). However, this was not detected in the CB group (flat regression line; p = 0.674). Patients with high leukocyte values had greater troponin release (entire cohort: p < 0.001; DN group: p < 0.001; CB group: steep regression line with p = 0.042). Longer CCT and ECT were associated with greater troponin release (entire cohort; both groups) and greater risk of fall in EF. In a direct comparison, fewer patients had significant deterioration of EF in the DN group than CB group (3.9 vs. 11.9%; p < 0.001).

CONCLUSION

 The use of CB cardioplegia may be beneficial in anemic patients, whereas the use of DN cardioplegia may be beneficial for expected long CCT and high leukocytosis.

SARS CoV-2 IgG seropositivity post-vaccination among dental professionals: a prospective study

BACKGROUND

The COVID-19 pandemic has spread very rapidly around the world. Various regional and national lockdowns were imposed to control the spread. Meanwhile, vaccine development and population vaccination were the next steps for pandemic control. Workers in the dental field, both dentists and dental assistants, however, were close to the sources of aerosol generated during dental procedures and thus were the group of workers the most exposed to COVID-19 infection. The aim of our study was to monitor the immune response before and after the vaccine in a high-risk population, composed by dental professionals.

METHODS

A clinical prospective study was carried out among dental professionals at the Academic Dental Polyclinic, Wroclaw Medical University (Wrocław, Lower Silesia region, Poland). Blood samples were collected at an interval of one year - March/April 2020, before the vaccination against COVID-19, and April 2021, after the vaccination. The analysis was performed on serum with four different methods: qualitative, semi-quantitative, and quantitative IgG count for SARS-CoV-2, and SARS-CoV-2 neutralizing antibodies.

RESULTS

A total of 42 healthy adult volunteers participated in the study. The results showed a statistically significant difference (p < 0.05) in antibody levels before and after vaccination (1st and 2nd measurement) for each test method. The tests that were used affected the results and the test that showed the strongest relationship with the result was the Qualitative test.

CONCLUSIONS

Dental professionals are the adult working population most at risk for COVID-19. Monitoring SARS-CoV-2-status-related seropositivity can provide useful information occupational risk factors for dental professionals.

MIH and Dental Caries in Children: A Systematic Review and Meta-Analysis

(1) Background: Molar-incisor hypomineralization (MIH) is a clinical condition affecting permanent teeth in children, with a documented rising trend in the last two decades. The aim of the present study was to analyze and synthesize the available evidence on caries experience (dmft/DMFT) and MIH in children. (2) Methods: A systematic review and meta-analysis were conducted according to the PRISMA statement. (3) Results: 59 papers published between 2007 and 2022 were included in the qualitative synthesis and 18 in the meta-analysis. The total sample of subjects was 17,717 (mean: 896), of which 2378 (13.4%) had MIH (mean: 119), with a girl/boy ratio of 1:1. The mean age of the enrolled participants was 8.6 (age range 7-10 years). Meta-analysis showed that MIH has a positive correlation with both dmft (effect size of 0.67, 95% CI [0.15, 1.19]) and DMFT (effect size of 0.56, 95% CI [0.41, 0.72]); (4) Conclusions: Children with MIH should be diagnosed correctly and on time. Treatment and management options for moderate and severe forms of MIH should consider prognosis based on known risk factors, and secondary and tertiary prevention policies should also consider the multifactorial nature of caries etiology.

Long-term outcomes of the Coordinated Care Program in Patients after Myocardial Infarction (KOS-MI)

BACKGROUND

The Coordinated Care in Myocardial Infarction Program (KOS-MI) was introduced to improve prognosis for patients after myocardial infarction (MI). The program includes complete revascularization followed by unrestricted access to rehabilitation, electrotherapy and cardiac care.

AIM

The aim of this study was to assess major adverse cardiac and cerebrovascular events (MACCE) of patients enrolled in the KOS-MI at 3-year follow-up.

METHODS

This is a retrospective, multicenter registry of patients treated for MI. Study group (KOS-MI) of 963 patients was compared to the control group (standard of care) of 1009 patients. At 3-year follow-up MACCE including death, MI, stroke and repeated revascularization were reported. Additionally, hospitalization due to heart failure (HF) was analyzed. Propensity score matching (PSM) was utilized for group baseline characteristics adjustment.

RESULTS

Patients in the KOS-MI group were younger (65 vs. 68; P < 0.001), mostly men (70% vs. 62.9%; P < 0.001), admitted with ST-elevation myocardial infarction (STEMI) (44.6% vs. 36.2%; P < 0.001). Patients in the control group had more comorbidities and were admitted more often with non ST-elevation myocardial infarction (63.8% vs. 55.4%; P < 0.001) and acute HF (5.1% vs. 2.7%; P = 0.007). Following PSM 530 well matched pairs were selected. At three years (92.3% follow-up completeness), the relative risk reduction was: 25% in MACCE (P = 0.008), 38% in mortality (P = 0.008), 29% in repeated revascularization(P = 0.04) and 28% (P = 0.0496) in hospitalization for HF in the KOS-MI group.

CONCLUSIONS

The combination of contemporary invasive techniques, complete revascularization, cardiac rehabilitation and ambulatory care included in the KOS-MI Program improves long-term prognosis of patients after MI up to 3-year follow-up.

Efficacy of ozonated water as a PS in photodynamic therapy: A tool for dental caries management? An in vitro study

Background

The most prevalent noncommunicable disease in the world is dental caries; and when it is not adequately treated, it is usually associated with tooth loss or severe dental lesions. In fact, expensive care or tooth extraction may be necessary due to the negative effects dental caries have on general health. This is due to its frequent pain and secondary bacterial infections. The aim of this study was to investigate the activity of ozonated water as such and in combination with appropriate light radiation so as to perform a photodynamic treatment (PDT) against the cariogenic bacterium Streptococcus mutans.

Design and methods

This work has been performed in vitro by using an S. mutans strain mainly structured in a biofilm status, reproducing the natural condition of the tooth infection. The ozone was tested at three different concentrations by using a commercial device able to generate different O3 formulations in water. The PDT treatment requires an appropriate light wavelength, evaluated in this work through the UV-Vis adsorption spectrum of the ozonated water.

Results

The obtained results suggested an effective and synergic property of O3 and light at 460-470 nm against this microorganism. The most antibiofilm activity was observed using a concentration of ozone of 0.06 mg/L alone as well as with PDT treatment.

Conclusions

The results are encouraging for additional research and in vitro/in vivo fresh experimental investigations to perform an exhaustive antimicrobial treatment protocol against the S. mutans tooth infection.

Platelet-rich plasma and platelet-rich fibrin in oral surgery: A narrative review

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are biological products derived from the plasma fraction of autologous blood that have a platelet concentration above that of the original blood. Cytokines and growth factors are present in platelet-based preparations, and their application has gained great attention in dentistry. The aim of this review was to comprehensively examine the latest scientific evidence on the use of PRF and PRP in oral surgery, and to describe current operational protocols. Platelet-rich fibrin is used after third molar extractions, in the treatment of alveolar osteitis and trismus, and in implant surgery. Platelet-rich plasma is utilized in sinus lift procedures, after tooth extractions, and in patients undergoing the treatment of bisphosphonate-related osteonecrosis of the jaw. Based on this review, plenty of data indicates that the PRF-PRP usage in oral surgery shows promising results. However, no consistent protocols have been presented in the analyzed articles. Further research is needed to provide clinicians with evidence-based clinical recommendations and to develop protocols on the use of these preparations in dental surgery.

Attachments for the Orthodontic Aligner Treatment-State of the Art-A Comprehensive Systematic Review

BACKGROUND

In recent years the burden of aligner treatment has been growing. However, the sole use of aligners is characterized by limitations; thus attachments are bonded to the teeth to improve aligner retention and tooth movement. Nevertheless, it is often still a challenge to clinically achieve the planned movement. Thus, the aim of this study is to discuss the evidence of the shape, placement and bonding of composite attachments.

METHODS

A query was carried out in six databases on 10 December 2022 using the search string ("orthodontics" OR "malocclusion" OR "Tooth movement techniques AND ("aligner*" OR "thermoformed splints" OR "invisible splint*" AND ("attachment*" OR "accessor*" OR "auxill*" AND "position*").

RESULTS

There were 209 potential articles identified. Finally, twenty-six articles were included. Four referred to attachment bonding, and twenty-two comprised the influence of composite attachment on movement efficacy. Quality assessment tools were used according to the study type.

CONCLUSIONS

The use of attachments significantly improves the expression of orthodontic movement and aligner retention. It is possible to indicate sites on the teeth where attachments have a better effect on tooth movement and to assess which attachments facilitate movement. The research received no external funding. The PROSPERO database number is CRD42022383276.

Friedman Tongue Position and the Anthropometric Parameters in Adult Patients with Obstructive Sleep Apnea: An Observational Study

INTRODUCTION

Obstructive Sleep Apnea Syndrome (OSAS) is a relevant public health problem; dentists can play an important role in screening patients with sleep disorders by using validated tools and referring patients to a specialist, thereby promoting an interdisciplinary approach. The aim of the study is to identify if the OSAS severity, measured by the apnea-hypopnea index (AHI), and some anthropometric measurements are associated with the Friedman Tongue Position (FTP) within a population with dysmetabolic comorbidities.

MATERIALS AND METHODS

A questionnaire containing information about clinical data including height, weight, Body Mass Index (BMI), neck circumference, waist circumference, hip circumference and FTP was administered. The AHI value was measured by means of an unattended home polysomnography device. Pearson correlation coefficients were calculated, and Kruskal-Wallis, Kolmogorov-Smirnov (both nonparametric) and independence tests were performed to probe the possible relationships. The significance was set at p ≤ 0.05.

RESULTS

A total of 357 subjects were analyzed. The association between the FTP and AHI was not statistically significant. On the contrary, the AHI showed a positive correlation with BMI and neck circumference. A statistically significant association between the number of subjects with a larger neck and an increasing FTP class was found. BMI, neck, hip and waist circumference was associated with the FTP scale.

CONCLUSIONS

although the FTP was not directly associated with OSAS severity, there was also evidence that an FTP increase is associated with an increase in the considered anthropometric parameters, and FTP can be a clinical tool used in the assessment of risk for OSAS risk factors.

Del Nido versus cold blood cardioplegia in adult patients with impaired ejection fraction undergoing valvular and complex heart surgery

BACKGROUND

There is sparse evidence on the efficacy of del Nido cardioplegia in high-risk patients with reduced ejection fraction undergoing valvular or complex heart surgery, and further investigation is required.

METHODS

An institutional registry was searched for patients who underwent valvular or complex heart surgery and had an ejection fraction <40%. Subjects who received del Nido cardioplegia (DNC) and cold blood cardioplegia (CBC) were selected. Propensity matching was performed with age, gender, and number of conducted procedures as matching criteria. A comparative analysis was performed on primary endpoints of the troponin rise and changes in ejection fraction (EF). A composite endpoint of a troponin rise of ≥20× baseline or fall of EF≥5% was assessed in a multivariate analysis. Other perioperative complications are reported.

RESULTS

One hundred patients from the DNC group were matched to the 100 patients in the CBC group. There were no differences between groups at baseline. Postoperatively, lower troponin values were observed in the DNC group at 12 hours (median; IQR: 523.2;349.1-740.4 pg/mL vs. 787.6;443.6-1689.0 pg/mL; P=0.016) and 36 hours (median; IQR: 426.1;337.2-492.1 pg/mL vs. 653.7;398.8-1737.5 pg/mL; P=0.044). Fewer patients in the DNC group had a fall in EF≥5% (7% vs. 16%; P=0.046). The multivariable analysis did not reveal a significant predictor of composite endpoint.

CONCLUSIONS

In patients with impaired contractility undergoing valvular and complex procedures, the use of del Nido cardioplegia as an alternative to cold blood cardioplegia is associated with lower troponin release and improved preservation of ejection fraction.

Enamel Analysis by 3D Scanning after Three Orthodontic Clean-Up Procedures: An In-Vitro Test of a New Piezoelectric Tool

(1) Background: To assess the clinical safety and efficacy of a new piezoelectric instrument for orthodontic clean-up; (2) Methods: An in-vitro comparative study on 75 teeth extracted for orthodontic reasons compared the tested method (Treatment 1) with two other procedures: One step finisher and polisher (Inverted cone One gloss Shofu Dental, Kyoto, Japan) (Treatment 2) and twelve-fluted tungsten carbide bur (123-603-00, Dentaurum, Pforzheim, Germany) and Sof-Lex discs Pop-On XT Kit (3M ESPE) (Treatment 3), with n:25 samples in each group. Clinical safety (enamel volume loss) and effectiveness (residual adhesive volume) were assessed using the structured light 3D scanner Atos Compact Scan (GOM GmbH) together with the support of Atos Professional software. The surfaces were scanned three times to assess: (i) the volume of the residual adhesive (RAV) after bracket removal; (ii) the volume of the relative residual adhesive (dAV) after the clean-up procedure; (iii) volume of the enamel loss (EVL); (3) Results: The mean RAV (mm³) was 0.239 ± 0.337; 0.069 ± 0.124, 0.120 ± 0.193 and the mean EVL (mm³) was 0.1870 ± 0.177, 0.187 ± 0.299 and 0.290 ± 0.205, for treatment 1, 2 and 3, respectively. The distribution was asymmetrical between groups in both cases; (4) Conclusions: The tested instrument proved to be effective and safe for post-orthodontic clean-up. With the increasing use of invisible aligners, the possibility of using an ergonomic and fast instrument is of benefit to both patient and practitioner.

Influence of Primary Palatal Surgery on Craniofacial Morphology in Patients with Cleft Palate Only (CPO)-Systematic Review with Meta-Analysis

BACKGROUND

Cleft palate only (CPO) is the second most prevalent cleft type. Both the cleft and palatal scarring may affect craniofacial growth. The aim of this systematic review was to summarize scientific evidence on effect of palatal surgery on craniofacial morphology in CPO.

METHODS

A search was conducted in PubMed, PMC, WoS, Scopus, Embase, using the keywords: "cleft palate" AND ("craniofacial morphology" OR "cephalometric analysis") NOT "lip" with inclusion and exclusion criteria ensuring confident, direct comparison between study groups. The quality assessment was performed with Arrive's scale for radiologic examinations.

RESULTS

Of 713 potential articles, 19 were subjected to qualitative analysis and 17 to meta-analysis, which confirmed reduced SNA in unoperated CPO versus non-cleft individuals. No scientific evidence was found directly assessing the effect of surgery on craniofacial morphology. The negative effect of palatal surgery was seen indirectly: in treated CPO versus non-cleft, the size effect of SNA is bigger than in untreated CPO versus non-cleft. A high heterogeneity came from a few non-European publications.

CONCLUSIONS

CPO is associated with sagittal maxillary deficiency resulting both from the cleft and from primary surgery, disregarding cleft severity in operated CPO patients. Ethnic differences influence craniofacial morphology in CPO. This research received no external funding. Study protocol number in PROSPERO database: CRD42021268957.

Quality of Life and Stress Management in Healthcare Professionals of a Dental Care Setting at a Teaching Hospital in Rome: Results of a Randomized Controlled Clinical Trial

In the healthcare environment, more and more people experience work-related stress. The Faculty of Medicine and Dentistry of Sapienza University of Rome, having observed the need to take care of healthcare professionals, has set itself the objective of providing useful tools such as additional and necessary personal protective equipment for healthcare professionals.

OBJECTIVE

To promote health through better management, skills, and the use of strategies and solutions to identify, decompress, and neutralize those responsible for work-related stress mechanisms in order to take care of those who care (CURARE CURANTES).

MATERIALS AND METHODS

A randomized controlled clinical trial was conducted. The participants were enrolled by three departments of the Department of Dental and Maxillofacial Sciences of Rome; in consideration of emotional involvement of health professionals who work there. A motivational program was offered.

RESULTS

There were 17 and 16 healthcare professionals in the intervention and control groups, respectively. Levels of the mental composite score (MCS) varied both in the pre-post phase of the intervention group (p = 0.002), and between the intervention group and control group in the post phase (p = 0.006). No significant differences were observed for the physical composite score (PCS). Similarly, there were no significant differences regarding the positivity scale (PS) and the two dimensions of work-related stress (job demand and decision latitude).

CONCLUSION

This study demonstrates the efficacy of yoga training practiced directly in the workplace and wearing work clothes, entering the work context, not weighing further on the healthcare workload, and being a way to carry out physical activity even in those cases in which professionals do not have the time to do it in their free time.

Incremental value of myocardial work in predicting beneficial response to aortic valve replacement in patients with aortic stenosis

 

The predictors of favorable clinical response to aortic valve replacement (AVR) in aortic stenosis (AS) are still insufficiently defined. The increased LV afterload in AS affects the interpretation of the majority of LV systolic indices, which are load-dependent. The estimation of myocardial work (MW) is a newly developed approach, which, allowing correction of global longitudinal strain (GLS) for LV afterload, gives a more adequate insight into the intrinsic LV contractility.

Aim

To investigate whether the assessment of MW can improve the prediction of clinical and neurohormonal improvement post AVR in patients with AS.

Methods

We evaluated 126 patients (75±9 years) with severe AS who underwent transcatheter AVR (n=100) or surgical AVR (n=26). Transthoracic echocardiography, blood sampling and 6 min walk test (6MWT) were performed pre and 3 months post AVR. The following indices of MW were assessed: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE).

Results

Post-AVR changes in the clinical and echocardiographic profile are presented in Table. Post-treatment increase in 6MWT distance was noted in 95 patients, and decrease in NT-proBNP in 94 patients. In multivariable analysis including clinical parameters and echocardiographic indices of cardiac function, morphology and aortic valve hemodynamic, baseline GWW was the only independent echocardiographic predictor of post-AVR improvement in 6MWT distance (beta=−0.24, SE 0.09, p=0.01), whereas baseline GWE was, in addition to tricuspid regurgitation pressure gradient (TRPG) and E/e' ratio, independently associated with the post-AVR decrease in NT-proBNP (beta=0.27, SE 0.09, p=0.004).

Conclusions

In patients with severe AS undergoing AVR, higher values of GWW do not favor post-treatment functional improvement as assessed by 6MWT. The beneficial neurohormonal response to AVR is more pronounced in patients with less efficient LV contraction at baseline.

Funding Acknowledgement

Type of funding sources: None.

How Does Orthodontic Mini-Implant Thread Minidesign Influence the Stability?—Systematic Review with Meta-Analysis

Background: Clinical guidelines are lacking for the use of orthodontic mini-implants (OMIs) in terms of scientific evidence referring to the choice of proper mini-design. Thus, the present study aimed to investigate to what extent orthodontic mini-implant thread design influences its stability. Methods: Search was conducted in five search engines on 10 May. Quality assessment was performed using study type specific scales. Whenever possible, meta-analysis was performed. Results: The search strategy identified 118 potential articles. Twenty papers were subjected to qualitative analysis and data from 8 papers—to meta-analysis. Studies included were characterized by high or medium quality. Four studies were considered as low quality. No clinical studies considering the number of threads, threads depth, or TSF have been found in the literature. Conclusions: Minidesign of OMIs seems to influence their stability in the bone. Thread pitch seems to be of special importance for OMIs retention—the more dense thread—the better stability. Thread depth seems to be of low importance for OMIs stability. There is no clear scientific evidence for optimal thread shape factor. Studies present in the literature vary greatly in study design and results reporting. Research received no external funding. Study protocol number in PROSPERO database: CRD42022340970.

Green dentistry: Organic toothpaste formulations. A literature review

Dentistry as a profession should take into account the goals of sustainable development in daily practice and encourage the transition to a green economy. Consumers are becoming more conscious about the impact of self-care products, including toothpastes, on the environment. Organic toothpastes are considered very safe. A broad literature review was conducted to: (i) identify the ingredients in available organic toothpastes; (ii) classify them into active and inactive; and (iii) evaluate each ingredient's purpose and the adverse events that may be associated with its use. A comprehensive list of available organic toothpastes and their ingredients was compiled based on the products from the largest Italian organic supermarket chain (NaturaSì®) that is representative of the European market. Then, PubMed, Scopus and Google Scholar databases were searched to identify, classify and evaluate each ingredient. The final sample consisted of 46 organic toothpastes that included 156 ingredients; 139 (89.1%) and 17 (10.9%) were classified as active and inactive, respectively. Overall, 32 (20.5%) ingredients were associated with known adverse events. The results of this study indicate that organic toothpastes are highly biocompatible with oral cavity tissues. Careful product selection may help consumers avoid potential adverse effects that can be caused by ingredients such as polymers (e.g., polyethylene glycol) and carbomers, detergent agents (e.g., sodium lauryl sulfate), and triclosan. The lack of clinical studies should encourage the development of sufficient evidence to provide consumers with recommendations for daily use, based on both efficacy and biocompatibility.

Treatment of Peri-Implant Mucositis with Standard of Care and Bioptron Hyperlight Therapy: A Randomized Clinical Trial

The aim of this study was to evaluate in a cohort of patients with peri-implant mucositis: (a) the efficacy of professional mechanical debridement therapy assisted using Bioptron Hyperlight Therapy on the reduction in periodontal indexes and (b) the reduction in total oxidative salivary stress. Forty subjects with a diagnosis of peri-implant mucositis were enrolled and randomly assigned to the Study Group (mechanical debridement therapy assisted using Bioptron Hyperlight Therapy) or Control Group (mechanical debridement therapy alone). The study duration was 6 months. Data on plaque index (PI), bleeding on probing (BoP), probing pocket depth (PPD), and pain relief on Visual Analogue Scale (VAS) were recorded at T0, T1 (14 days), T2 (1 month), and T3 (6 months). Group differences were assessed using Student's t-test and Pearson's Chi-squared test of homogeneity. PI and PPD decreased in the Study Group at the [T0; T1] time interval and during the overall time of observation significantly more than in the Control Group; BoP and pain on VAS decreased significantly faster in the Study Group than in the Control Group. Differences in Salivary Antioxidant Test (SAT) changes were not significant at any time interval. Patients' gender and smoking habit were not correlated with the clinical outcomes. Clinical parameters related to peri-implant mucositis significantly improved in the Study Group, which demonstrated the clinical efficacy of the Bioptron Hyperlight Therapy as an adjunct to standard of care for the treatment of peri-implant mucositis. The RCT was registered at the US National Institutes of Health #NCT05307445.

In-vivo colour stability of enamel after ICON® treatment at 6 years of follow-up: a prospective single center study

OBJECTIVES

This in-vivo clinical study provides subjective and objective documentation on colour stability of enamel after resin infiltration at a mean observation time of six years after treatment.

METHODS

76 teeth previously treated with ICON® due to hypomineralized lesions of enamel were recalled for a follow-up at ………(………..). Colour stability was assessed: i) subjectively by patients using FDI-colour matching criteria; ii) objectively by calculating CIEDE2000 colour differences between the affected/treated and sound enamel in each tooth at T0 (baseline), T1 (one year) and T2 (six years) based on spectrophotometric data. Analysis of correlation between FDI and CIEDE2000 data was performed.

RESULTS

Two teeth were lost to follow-up prior to 72 months. No unwanted effects were reported by patients. Number of FDI scores 1 and 2 were 13.5%, 90.6% and 93.2% at T0, T1 and T2, respectively. ΔE00 was evaluated at 6.8 (SD3.8) at T0. ΔE00 was 5.8 (SD3.1) between T0 and T1 and 1.3 (SD0.6) between T1 and T2. ΔE00 reduction (T1-T0) was significantly but only fairly correlated with FDI scores at any follow-up.

CONCLUSIONS

This study shows that caries infiltration satisfactorily masks aesthetically relevant lesions after longer follow-up. Subjective and objective outcomes showed a fair correlation mainly for the initial masking effect.

CLINICAL SIGNIFICANCE

This prospective clinical trial demonstrates the excellent subjective and objective colorimetric stability of enamel treated with ICON® 6 years after treatment.

How Did the COVID-19 Pandemic Effect Dental Patients? An Italian Observational Survey Study

The primary aim of this observational survey study was to assess patients' attitudes toward clinical dental practice during the COVID-19 pandemic; the secondary aim was to evaluate patients' attitudes towards oral health by maintaining an appropriate lifestyle and oral hygiene at home. The questionnaire was developed using Google Forms. The questionnaire consisted of three parts: Part A-geographic, demographic, and personal data; Part B-patients' attitude toward oral health selfcare and lifestyle; Part C-patients' attitude toward dental practice. This survey, conducted during the months of November and December 2020, enrolled 1135 subjects throughout Italy. All data were statistically analyzed. COVID-19 has changed patients' approach to dental procedures. Most of the people interviewed lived in families, and their greatest fear was infecting a family member. Restrictive measures forced people to stay at home, which led to an increased consumption of various types of food, including cariogenic foods. People said they felt safe when they went to the dentist, but they also paid special attention to measures to prevent contagion. Among the measures that should be introduced in similar situations in the future, people wanted telemedicine, a phone recall, and the possible use of video clips for home oral care instructions.

Long term outcomes of a coordinate care program in patients after myocardial infarction (KOS-MI)

Introduction

Despite significant progress in treatment of myocardial infarction (MI), the annual mortality remains a challenge. Since 2017, The Coordinated Care in Myocardial Infarction Program (KOS-MI) has been introduced in Poland, which guarantees and coordinates patients to achieve complete revascularization, electrotherapy when necessary, cardiac rehabilitation and access to cardiologist for patients after MI.

Purpose

The aim of this study was to assess long term outcomes (3-year follow-up) of patients enrolled in KOS-MI.

Methods

This is a prospective multicenter registry of 1973 consecutive patients with myocardial infarction hospitalized in 4 centers of American Heart of Poland from 11.2017 to 11.2018. Patients which constituted a study group were enrolled in KOS-MI program at discharge. A control group consisted patients who received standard of care. Propensity score matching was utilized for patients baseline characteristic matching and results adjustment. Follow-up was obtained from the National Health Fund registry citizens. Combine endpoint of MACCE consisted of death, MI, stroke and repeated revascularization.

Results

In total 753 patients were enrolled in KOS program and 1173 constituted a control group. More than 90% of patients in both groups underwent PCI. Patients in KOS-MI were mostly men (70% vs. 65%; p&lt;0,05), were younger (65 vs. 68; p&lt;0,05), admitted with STEMI (44,8% vs. 37,5%; p&lt;0,05) with previous history of heart failure (23% vs. 17%; p&lt;0,05). Patients in the control group had more comorbidities: chronic kidney disease (9,8% vs. 4,4%; p&lt;0,05), previous AMI (17,6% vs. 12,6%; p&lt;0,05), prior PCI (15,7% vs. 11%; p&lt;0,05) and atrial fibrillation (11,7% vs. 8,4%; p&lt;0,05). They were more often admitted with NSTEMI (62,5% vs. 55,3%; p&lt;0,05) and acute heart failure (4,7% vs. 2,7%; p&lt;0,05). KOS patients had more often completed revascularization performed (50% vs. 33,4%; p&lt;0,05). Following propensity score matching 576 pairs were matched, and patient baseline characteristic were well balanced in all variables.

In long- term follow-up (mean 2,8±0,27 years) mortality was significantly lower in KOS group (9% vs. 16,3%; p&lt;0,05) and MI similar (10,8% vs. 13,1%; p=0,14). MACCE was higher in the control group (43% vs. 30,2%; p&lt;0,05). Prevalence of hospitalization for HF and repeated revascularization was higher in the control group (14,7% vs. 9,4%; p&lt;0,05 and 27,9% vs. 21%; p&lt;0,05, respectively). After adjustment MACCE remained significantly lower for KOS-MI, whereas there was tendency for lower mortality, hospitalization for HF and repeated revascularizations (Figure 1).

Conclusions

Combination and coordination of unrestricted rehabilitation, complete revascularization, electrotherapy and ambulatory cardiologist care in the KOS-MI program improves long term prognosis in patients after MI.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Risk Management for a Legally Valid Informed Consent

ABSTRACT

Gelli-Bianco law (Law no. 24/2017) intervenes both in order to divide healthcare liability between the healthcare professional and the facility in which he/she exercises and to incentivize the latter to adopt an organizational model suitable for managing the risk associated with the provision of any healthcare service, including the information for consent. In fact, the healthcare facility must guarantee clear, complete and adequate information on the specific case, which, therefore, cannot consist of standard forms to be signed by the patient, under penalty of a flawed consent to treatment and consequent healthcare liability in the event of an adverse event. The regulation mandates that safety must be guaranteed through proper prevention tools and health care risk management, in con-junction with the most effective use of structural, technological and organizational resources available. It further spells out the obligation of health care professionals to contribute to risk prevention while administering health care procedures. For this reason, the consent information constitutes a source of risk for the responsibility of the healthcare provider and the Facility and it must necessarily be managed. Risk Management is the management tool that can allow the healthcare facility to improve the quality and safety of the services provided, optimizing the risk of adverse events through proper moni-toring of the same. This paper will be published, following a special agreement, on the two journals "Igiene e Sanità Pubblica" and "La Clinica Tera-peutica", in Italian and in English, in order to increase the diffusion to a wider audience.

What causes failure of fixed orthodontic retention? - systematic review and meta-analysis of clinical studies

BACKGROUND

Orthodontic retention aims to maintain optimal teeth positions after active treatment. The stability is affected by numerous factors, including patients' individual features, thus retention should be adjusted in the most optimal way. Bonding a retainer makes retention less dependent on patient's compliance.

QUESTIONS ARISE

What wire or fiber splint type provides the best treatment stability? What materials should be used to bond the wire or fiber splint? Should be the bonding procedure be direct or indirect? The aim of the study is to assess and synthesize available controlled trials investigating failures of fixed retainers.

METHODS

Literature searches of free text and MeSH terms were performed in Scopus, Web of Science, Embase and PubMed Central in order to find studies, referring to failures of fixed retention (12th February 2021). The keywords were: ("orthodontic retainers AND failure AND wire"). The framework of this systematic review according to PICO was: Population: orthodontic patients; Intervention: fixed orthodontic retainer bonding; Comparison: Different protocols of fixed orthodontic retention applied; Outcomes: failure rate, survival rate. Three different specific scales from the Cochrane Collaboration Handbook were used, according to each study type. Additionally, a meta-analysis was conducted to compare the effectiveness of retention using fiber reinforced composite and multistranded steel wire.

RESULTS

The search identified 177 potential articles: 114 from PubMed, 41 from Scopus, 20 from Web of Science and 2 from Embase. After excluding studies inconsistent with selection criteria, 21 studies were included and subjected to qualitative analysis. The main outcome investigated was failure rate. This systematic review has some potential limitations due to the heterogeneity of design between included studies.

CONCLUSIONS

No retainer is proved to guarantee a perfect stability of dental alignment. The retainer should be bonded to all adherent teeth, preferably with additional use of bonding resin. No wire or fiber splint present superior characteristics concerning failure rate. Fiber reinforced composite retention is more sensitive to operator skills, and with imperfect bonding technique, failure rate is much higher. During the first 6 months after bonding retainer the patient should be under frequent control. The study protocol was registered in PROSPERO database with the number CRD42021233406.

A computed tomography comprehensive evaluation of the ostium of the sphenoid sinus and its clinical significance

BACKGROUND

The purpose of this research was to evaluate the size of the sphenoid sinuses' ostia, the distance between them and the distance between the medial margin of the ostia and the median line in the Polish adult population.

MATERIALS AND METHODS

The analysis was undertaken as a retrospective study of 296 computed tomography (CT) scans of patients (147 females, 149 males) with no comorbidities in their sphenoid sinuses. The paranasal sinuses were investigated by using Spiral CT Scanner (Siemens Somatom Sensation 16), in the option Siemens CARE Dose 4D, without administering any contrast medium. Having obtained transverse planes, multiplans reconstruction tool was used in order to glean sagittal and frontal planes.

RESULTS

The average size of both sphenoid sinuses ostia was 0.31 cm for both genders (for females ranging from 0.1 to 0.5 cm and from 0.1 to 0.6 cm for males). The mean distance between both sphenoid sinuses ostia was 0.6 cm for both genders (the range for females was 0.1-1.4 cm, whereas 0.1-1.8 cm for males). The average distance between the medial margin of the ostium and the median line was 0.32 cm for both genders (0.31 cm for females in the range of 0-0.9 cm and 0.32 cm for males in the range of 0-1 cm).

CONCLUSIONS

Intraoperative identification of the sphenoid sinus ostia might prove difficult and their inadequate excision could lead to potential iatrogenic complications, hence detailed anatomical descriptions are still warranted in specific populations in order to perform safe and effective procedures.

AB0601 COMPARISON OF THE EFFECT OF DIFFERENT PHYSICAL THERAPY PROGRAM IN THE REHABILITATION OF KNEE OSTEOARTHRITIS PATIENTS

Background:

Knee osteoarthritis (OA) is an increasingly common and disabling problem in worldwide. Exercises are considered the cornerstone of non-surgical management of knee OA and is recommended in all current clinical guidelines. The diversity of exercise programs determines the need to compare their efficiency, in order to recommend the best option for the patient.

Objectives:

The aim of the present study was to compare the effect on knee functionality of conventional exercises program and combinate with manual therapy in patients with knee osteoarthritis.

Methods:

164 patients that fulfilled the ACR classification criteria for knee osteoarthritis (127 females and 37 males) ranging in age from 42 to 84 years (mean 62,2 SD 8,76), participated in a 10 days two-arm randomized trial. One group (Gr.1) received an exercises program, the other group additionally manual therapy methods (Gr.2). Pain and function were measured with a Visual Analogue Scale (VAS, mm) and Knee Injury and Osteoarthritis Outcomes Score (KOOS) with 5 domains (Pain, Symptoms, Activity in Daily Living (ADL), Sport and recreation (Sport/rec.) and Quality of life (QoL)).

Results:

In the Gr.1 were 82 patients mean age 61,8±9,2 years and in Gr.2 – 82 patients 62,7±8,3 years (p>0.05). The initial level of pain (63,4±14,2 vs 60,2±18,8mm) and knee functionality according to KOOS (Tab1.) were similar in both groups, p>0.05. After 10 days rehabilitation program, VAS in Gr.1 was 39,6±14,8 mm, in Gr.2- 28,5±11,6 mm, (p<0.01). The KOOS results at the end of the rehabilitation program were with improvement, statistically significative in the Gr.2 (p<0,05).

Table 1.

The KOOS results at baseline and after 10 days of rehabilitation program.

KOOS scales(M±SD), %Group 1Group 2BaselineAfter 10 daysBaselineAfter 10 daysPain55,5 ±13,863,4±13,653,0±22,364,3±19,1Symptoms59,0±18,765,6±18,156,6±19,069,0±15,9ADL46,3±15,554,5±16,043,0±19,955,1±18,2Sport/rec15,6±17,323,1±19,616,0±24,330,5±23,6QoL29,3±22,236,5± 22,934,8±23,950,6±18,9

Conclusion:

The reduction of pain and recovery of function were found in both groups, with better results in patients who received manual therapy and exercises program. This study supports the routine manual therapy in rehabilitation program in patients with knee osteoarthritis.

Disclosure of Interests:

None declared.

Long-Term Effectiveness of Treating Dentin Hypersensitivity with Bifluorid 10 and Futurabond U: A Split-Mouth Randomized Double-Blind Clinical Trial

Background: The definition of dental hypersensitivity is “pain derived from exposed dentin in response to chemical, thermal tactile or osmotic stimuli which cannot be explained as arising from any other dental defect or disease”. One of the treatments proposed is tubular occlusion. The aim of this in vivo split-mouth randomized clinical trial was to evaluate the clinical efficacy of a in-office application of a fluoride varnish (Bifluorid 10) and a bonding resin (Futurabond U) in adults with dentin hypersensitivity. Material and methods: A total of 180 teeth were treated with Bifluorid 10 and 160 with Futurabond U. Outcome measurements were taken one or two weeks before treatment, at baseline at the application days, at 1 week and at 1–6 months after first treatment. Results: Both treatments reduced pain intensity. Bifluorid 10 and Futurabond U have similar efficacy in reducing SCHIFF-measured pain reduction, while Bifluorid 10 is significantly more efficient for VAS-measured pain reduction, mainly due to long-term pain reduction. Patient age has a significant negative influence on pain reduction, while the influence of patient gender and BEWE of the tooth is insignificant. Conclusions: Bifluorid 10 and Futurabond U are effective in the treatment of dental hypersensitivity. The RCT was registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT04813848.

Risk management and Healthcare responsibility. How to guarantee legal protection in Medicine

Having regard to the increasing attention to the issue of safety and health of patients and workers by low, the hypothesis that this topic will be the growing trend in the next years does not seem to be manifestly unfounded. For this reason, it is wise for healthcare professionals to already be aware that any violation of the interests underlying the legislation in question entails a ruling on civil and/or criminal liability. It is therefore necessary to identify the most suitable means to prevent undue harm occurring, partly to exempt healthcare professionals and hospitals from compensation costs, thereby providing them with recourse to insurance coverage. Healthcare facility organisations must adopt Risk Management techniques as a tool to simultaneously guarantee the effectiveness of health services (in this case), the efficiency of the management economy, and finally compliance with all legally required precautions. This will relegate the occurrence of an adverse event to remote and unpredictable hypotheses, thus guaranteeing useful recourse to insurance coverage to compensate any harm that does occur.

Impact of Green Tea (Camellia Sinensis) on periodontitis and caries. Systematic review and meta-analysis

Background

The oral health-promoting effects of green tea are attributed to its polyphenol components. Aim of this work was to systematically review the literature in search for clinical trials assessing green tea for managing periodontitis and caries.

Methods

Randomized clinical trials comparing the efficacy of green tea versus control groups in oral hygiene and gingival health; periodontitis; caries; periodontal pathogens number; Streptococcus mutans, Lactobacillus spp. Meta-analysis and meta-regression analysis were performed.

Literature searches were carried out using MedLine (PubMed), Scopus, and the Cochrane Library. Eighteen studies (870 subjects) were included.

Results

Green tea treatment had medium positive effect size in reducing GI (SMD: 0.50; 95%CI: −0.02/1.01); PI (SMD: 0.54; 95%CI: 0.14/0.95); GBI (SMD: 0.58; 95%CI: −0.41/1.56) and BOP (SMD: 0.52; 95%CI: −0.57/1.60) in respect to the control group. Splitting to subgroups, green tea showed a small negative effect in the chlorhexidine control groups. Green tea treatment had medium positive effect size in reducing CAL (SMD 0.58; 95%CI: −0.49/1.65) and large positive effect size in reducing PPD (SMD:1.02; 95%CI: 0.45/1.59).

Conclusion

Even if the results are encouraging, there is insufficient evidence to recommend the use of green tea formulation as first choice treatment for gingivitis, periodontitis and caries.

Detecting white spot lesions on dental photography using deep learning: A pilot study

OBJECTIVES

We aimed to apply deep learning to detect white spot lesions in dental photographs.

METHODS

Using 434 photographic images of 51 patients, a dataset of 2781 cropped tooth segments was generated. Pixelwise annotations of sound enamel as well as fluorotic, carious or other types of hypomineralized lesions were generated by experts and assessed by an independent second reviewer. The union of the reviewed annotations were used to segment the hard tissues (region-of-interest, ROI) of each image. SqueezeNet was employed for modelling. We trained models to detect (1) any white spot lesions, (2) fluorotic lesions and (3) other-than-fluorotic lesions. Modeling was performed on both the cropped and the ROI images and using ten-times repeated five-fold cross-validation. Feature visualization was applied to visualize salient areas.

RESULTS

Lesion prevalence was 37 %; the majority of lesions (24 %) were fluorotic. None of the metrics differed significantly between the models trained on cropped and ROI imagery (p > 0.05/t-test). Mean accuracies ranged between 0.81-0.84, without significant differences between models trained to detect any, fluorotic or other-than-fluorotic lesions (p > 0.05). Specificities were 0.85-0.86; sensitivities were lower (0.58-0.66). Models to detect any lesions showed positive/negative predictive values (PPV/NPV) between 0.77-0.80, those to detect fluorotic lesions 0.67 (PPV) to 0.86 (NPV), and those to detect other-than-fluorotic lesions 0.46 (PPV) to 0.93 (NPV). Light reflections were the main reason for false positive detections.

CONCLUSIONS

Deep learning showed satisfying accuracy to detect white spot lesions, particularly fluorosis. Some models showed limited stability given the small sample available.

CLINICAL SIGNIFICANCE

Deep learning is suitable for automated classification of retro- or prospectively collected imagery and may assist practitioners in discriminating white spot lesions. Future studies should expand the scope into more granular multi-class detections on a larger and more generalizable dataset.

Anatomical variations of the superficial ulnar artery: case series observed on historical specimens prepared by Ludwik Karol Teichmann

BACKGROUND

In this report we present a series of cases representing variant origin and course of the ulnar artery, namely the superficial ulnar artery, observed during the review of collection of historical specimens prepared in the 19th century by the prominent Polish anatomist Ludwik Karol Teichmann and his collaborators, exhibited in the Anatomy Museum of Jagiellonian University Medical College.

RESULTS

Three distinct variants of the superficial ulnar artery were found on anatomical specimens of the upper limb with arteries injected by using Teichmann's method. In case No. 1, the superficial ulnar artery originated from the brachial artery slightly above the interepicondylar line of the humerus. This aberrant vessel gave off the common interosseous artery in the upper half of the cubital fossa and then ran superficially to the bicipital aponeurosis and over the muscles arising from the medial epicondyle of the humerus. The cases No. 2 and 3 involved two similar variants of the superficial artery in which the common interosseous artery arose from the radial artery. In the unique case No. 4, the superficial ulnar artery arose from the radial artery.

CONCLUSIONS

The superficial ulnar artery shows diverse anatomy regarding its topography and blood supply territory. Orthopedic, hand, and plastic surgeons should be aware of anatomic variations of the SUA both in planning and in conducting surgeries of the upper limb.

Challenges in diagnosing and managing non-cavitated occlusal caries lesions. A Literature overview and a report of a case

AIM

Aim of this literature overview was to analyze the diagnostic procedures of hidden caries lesions and to present a restorative protocol.

METHODS

A literature overview was performed in order to evaluate hidden caries etiological hypothesis and the reported prevalence. The diagnostic procedure is performed with the aid of an intra-oral fluorescence based camera and the restorative procedure is completed with the use of a novel bisphenol-A free composite.

RESULTS

Non cavitated occlusal caries lesions prevalence is high in young adults population. Diagnosis of hidden caries requires both high sensitivity and specificity.

CONCLUSIONS

The novel diagnostic and restorative protocol showed to be highly effective in hidden caries assessment and restoration.

Kinesiology Taping as an Innovative Measure against Post-Operative Complications after Third Molar Extraction-Systematic Review

There are many randomized clinical trials suggesting a positive effect of kinesiotaping on postoperative swelling. In dentistry, however, the use of kinesiotaping still seems to be innovative, since not many articles on kinesiotaping within the craniofacial area have been published. This study aimed to systematically review and synthesize available controlled trials examining the use of kinesiotaping to reduce morbidity after third molar extraction. Literature searches for free text and MeSH terms were performed using five search engines, and used to find studies which focused on kinesiotaping as a form of rehabilitation after third molar extraction. The keywords used in the search were: “((“molar, third”[MeSH Terms] OR (“molar”[All Fields] AND “third”[All Fields]) OR “third molar”[All Fields] OR (“third”[All Fields] AND “molar”[All Fields])) AND extraction [All Fields]) AND “kinesiology”[All Fields]”. For the assessment of the risk of bias, the Jadad and Maastricht scales were applied. The search strategy identified 317 potential articles. After analysis, 10 papers were included in the final evaluation. Despite the fact that most of the included articles adhered to methodological standards, the fact that there are only a few of them points to a further need for scientific development of physiotherapy in this regard. Kinesiology taping is useful against post-operative morbidity of the third molar extraction site. The present studies show a low level of the risk of bias, but they are limited in number; therefore, it seems that more research is needed.

Correlation between Vista Cam, ICDAS-II, X-ray bitewings and cavity extent after lesion excavation: an in-vivo pilot study

BACKGROUND

To correlate fluorescence-based camera (FC), visual inspection (ICDAS-II) and radiographic examination X-rays bitewings (BW) to the extent of caries after excavation.

METHODS

The occlusal sites of 20 permanent first and second molars in 14 young adolescents (12±2 years old) were examined at 1^st Observation Unit of Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome. All the enrolled patients were asked to provide with X-rays bitewing of the studied teeth. The assessment of ICDAS-II and FC was performed by a trained operator. Then a second blind operator removed the carious lesion and evaluated the cavity extent (depth, width, length) after caries removal with a calibrated probe. To correlate FC measurements with bitewing sensitivity, 10 dentists evaluated the presence/absence of caries on the X-rays.

RESULTS

All the occlusal sites assessed by fluorescence camera, ranged from 1.7 to 2, indicating in all cases deep enamel lesions with possible extent to dentine with a mean of 1.7±0. In accordance, visual inspection by ICDAS-II showed scores of 3 and 4. By contrast, the radiographic documentation, i.e. bitewing X-rays, was evaluated in only 6 cases as presence of caries. The extent of the cavities was determined by three consecutive measurements: depth, width and length, with a mean of 3.5+1.73, 2.8+1.07 and 3.2+1.64 mm respectively. These results confirmed the agreement between FC and ICDAS-II for diagnosis of cavities with extent to enamel and dentine, while showed the low sensitivity of bitewings X-rays, in accordance with the existing evidence in Literature. Moreover, the results of this study for the first time provide information about the cavity extent after caries removal for the occlusal sites with ICDAS-II 3 and 4 scores and FC≥1.7.

CONCLUSIONS

X-rays evaluation showed diagnostic accuracy in 6% of the sample. VistaCam measurement of 1.7 was correlated to a cavity with 3.5, 2.8 and 3.2 mm of depth, width and length.

Analysis of Instagram® Posts Referring to Cleft Lip

Background: Social media has become a source of medical information. Cleft lip and palate is a visible congenital anomaly. The aim of the study was to analyze Instagram^® posts on the topic of cleft lip. Methods: Instagram^® posts with “#cleftlip” from March 2014–March 2017 were accessed. Separate lists of expressions (hashtags, meaningful words, words with emojis or emojis alone) were prepared for primary posts and for replies. Thirty expressions statistically most frequent in primary versus secondary posts and 30 in secondary versus primary posts were identified (Group 1) as well as 30 English words or hashtags (Group 2), non-English words or hashtags (Group 3) and emojis (Group 4). The frequencies of expressions were compared (Z-test for the difference of two population proportions). Results: There were 34,129 posts, (5427 primary posts and 28,702 replies), containing 62,163 expressions, (35,004 in primary posts). The occurrence of all expressions was 454,162, (225,418 in primary posts and 228,744 in replies). Posts with positive expressions such as “beautiful”, “love”, “cute”, “great”, “awesome” occurred more often than these with negative ones. In replies all emojis were positive. Conclusions: Numerous Instagram^® posts referring to cleft lip are published and do provoke discussion. People express their solidarity and sympathize with persons affected by cleft.

Impact of lactoferrin on bone regenerative processes and its possible implementation in oral surgery - a systematic review of novel studies with metanalysis and metaregression

Background

Lactoferrin is an iron – binding glycoprotein with anti-inflammatory and anabolic properties found in many internal fluids. It is worth looking at novel studies, because of their methodology and observations that may once be applicable in modern implantology.

The aim of the study is to answer the question if lactoferrin is a promising factor for bone regenerative process in oral surgery.

Method

An electronic search was conducted on 14th October 2019 on the PubMed, Scopus and Web of Science databases. The keywords used in the search strategy were: lactoferrin AND bone regeneration AND oral surgery. The qualitative evaluation was conducted using the Jadad and Newcastle-Ottawa Quality Assessment Form. Then a metanalysis of a new bone growth and percentage of the resorbed graft were performed with the metaregression of lactoferrin dose to its outcome effects on bone regeneration.

Results

The search strategy identified potential articles: 133 from PubMed, 2 from Scopus, 4 from Web of science. After removal of duplicates, 136 articles were analyzed. Subsequently, 131 papers were excluded because they did not meet the inclusion criteria. The remaining 5 papers were included in the qualitative synthesis. The use of lactoferrin clearly increases the growth of a newly formed bone (2.58, CI:[0.79, 4.37]), as well as shortens the time of the graft resorption (− 1.70, Cl:[3.43, 0.03]) and replaces it with a species-specific bone. Heterogeneity is significant at p < 0.001 level. Metaregression indicates that one unit increase in the log (Treatment dose), i.e. a 2.78 times increase of the Treatment dose, results in an increase of the Effect size by 0.682.

Conclusions

The use of lactoferrin both systemically and locally promotes anabolic processes (new bone formation). There is a relationship between the increase in administered dose of lactoferrin and the intensity of new bone formation. However, it is not only necessary to continue experimental research, but also to extend it to the clinical studies on patients, due to the limitations of different animal model research and different methodology, to introduce lactoferrin as a standard procedure for the treatment of bone defects, because it is a promising product.

The Influence of Dental Occlusion on Spectrophotometric Tooth Color Determinations

Background:

Shade matching is a significant treatment step and a challenge for the clinical team with potentially high costs for color correction. Currently, in the United States, the majority of private dental practitioners use visual color matching, but a recent study has reported a high rate of mistakes of subjective color determination among graduate dentists.

Objective:

The aim of this retrospective study is to analyze whether a change in the oral background due to dental occlusion can influence tooth color determination.

Methods:

Volunteer dental students underwent spectrophotometric color assessment using the SpectroShade device. Two measurements were carried out (with the individuals’ occlusion closed and with the occlusion open) on 43 upper central and 58 lateral incisors. Association between colorimetric variables L*, a*, b* and ΔE00 and tooth width, length and tobacco usage were examined.

Results:

Slight changes in the CIELAB values between closed and open occlusions were found for both the gingival and the central sections as for the overall tooth area, with mean ΔL*=-1.24, Δa*=-1.77, Δb*=-1.42 and ΔE00=1,84. A larger difference was detected in the incisal area, with mean ΔL*=-2.99, Δa*=-1.76, Δb*=-2.83 and ΔE00=3.65.

Conclusion:

In conclusion, our study showed that dental occlusion does not play a significant role in tooth color matching determinations, even though attention to avoid overbite due to a maximum intercuspation should be made.

The dimensions of the sphenoid sinuses: evaluation before the functional endoscopic sinus surgery

BACKGROUND

The following study aimed to evaluate the dimensions (anteroposterior, transverse and vertical) of the sphenoid sinuses in the adult population.

MATERIALS AND METHODS

The study was conducted as a retrospective analysis of the computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females and 149 males), who did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were done with the spiral CT scanner, without using any contrast medium. After obtaining transverse planes, frontal and sagittal planes were created using secondary reconstruction tool.

RESULTS

The anteroposterior dimension was found to be 2.65 cm on average, in the range of 0.5-4.3 cm. The transverse dimension was on average 1.98 cm, ranging from 0.5 cm to 4.9 cm. The average vertical dimension was found to be 2.1 cm, in the range of 0.7-3.7 cm.

CONCLUSIONS

Due to the high incidence of the anatomical variants of the paranasal sinuses, a CT scan is recommended in all patients before a planned surgery in order to avoid the potential iatrogenic complications. Dimensions of the sphenoid sinuses might point towards more at risk variants, but there is still a substantial amount of research that needs to be done in that aspect.

AB1316-HPR COMORBIDITIES IMPACT ON PHYSICAL REHABILITATION PROGRAM OUTCOMES IN PATIENTS WITH KNEE OSTEOARTHRITIS

Background:

Physical rehabilitation is proposed as a method of non-pharmacological treatment of knee osteoarthritis (OA) by the EULAR and OARSI recommendations. At the same time, presence of concomitant diseases could influence the condition of patients and the outcomes of the rehabilitation program.

Objectives:

To evaluate the frequency of comorbidities in OA patients and to appreciate their impact on outcomes of the physical rehabilitation program.

Methods:

A prospective control case study was conducted in the University Rehabilitation Center. The patients underwent clinical examination, VAS scale was used to assess level of pain, and Knee Injury and Osteoarthritis Outcome Score (KOOS) with 5 domains (Pain, Symptoms, ADL, Sport, QoL) for joint function assessment. These parameters were evaluated at the onset of the program (T0) and at the end of the 10th day (T1). Medical data records, general clinical exam and Charlson Comorbidities Index (CCI) assessed the comorbidities.

Results:

48 patients with OA were included in the study, 37 patients of them were found with comorbidities. The most frequent associated diseases were: cardiovascular- 76.6%, obesity-59.9%, and endocrine - 12.9% cases. At T0, significantly lower levels in the group with comorbidities were identified on the domains Pain, Sport and QoL. The CCI in patients with comorbidities was 3.29 ± 0.14 points (82.1% for 1-year survival rate). At the T1 moment, we found an improvement in joint functionality in both groups. The mean value of the VAS score group of patients without comorbidities decreased from 48,18 mm to 21,36 mm (p <0.05) and for the group of patients with comorbidities – 64,2 at / 36,2 mm (p<0.001). Significant improvement in joint function in the comorbidities group was in Pain (p <0.01), Sport (p <0.05) and Qol (p <0.01) domains, at the same in patients without comorbidities, the improvement was significant in all 5 domains.

Conclusion:

Comorbidities are highly associated to knee osteoarthritis and prove to have a negative influence on the results of the physical rehabilitation program; therefore, we would recommend to apply individualized rehabilitation programs adapted to the associated conditions of each patient.

Disclosure of Interests:

None declared

SAT0232 PERCEPTION OF THE DISEASE IN PATIENTS WITH EARLY SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus is an autoimmune disease with a major impact on patient’s quality of life.

Objectives:

To evaluate patient’s attitude toward early disease and factors that influence it.

Methods:

Performed case-control study included SLE patients that fulfilled SLICC, 2012 classification criteria. The research included two groups of patients: early SLE – 1stgroup (disease duration ≤24 months) and non-early SLE – 2ndgroup control (disease duration >24 months). The pattern of the disease activity was assessed by patient global assessment (PGA), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and Systemic Lupus Activity Measure (SLAM), for SLE activity, SLICC/ACR Damage Index (DI) for disease irreversible changes and SF-8 for the Quality of Life (QoL).

Results:

A total of 101 SLE patients with 34 in the 1stgroup (early SLE) and 67 in the 2ndgroup (non-early SLE) was analyzed. The disease activity showed high disease activity in both groups by SLEDAI (7,02±4,16 and 6,26±4,43 points, p>0,05) and SLAM (7,47±4,40 and 7,31±4,10 points, p>0,05) such as (46,97±19,39 vs 47,98±22,41 points). The QoL was appreciated as low, by both components (mental and physical), in groups. The damage index was higher in the 2nd group (0,23±0,43 and 1,07±1,29, p<0,001), which can be explained by the development of irreversible changes with the increase of disease duration.

The PGA in early SLE was influenced by subjective symptoms contained in SLAM index (r=0,48, p<0,05), such as fatigue and depression, and the level of the quality of life (r=0,65, p<0,001). Meantime, PGA in patients with longer disease duration (>2 years), was influenced by the presence of organ damage by SLICC/ACR DI (0,23, p<0,05) and objective findings of the disease activity contained in SLEDAI (r=0,33, p<0,005) and SLAM (0,44, p<0,001).

Conclusion:

The disease recognition in patients with early SLE was determined by subjective and psycho-emotional signs, while in patients with longer disease duration it was influenced by organ damage and complications.

References:

no references

Disclosure of Interests:

None declared

AB0360 EFFICACY AND SAFETY OF THE PROSTAGLANDIN EP4 RECEPTOR ANTAGONIST CR6086 ADDED TO METHOTREXATE IN DMARD-NAÏVE EARLY RA PATIENTS: A PHASE 2 RANDOMIZED CONTROLLED TRIAL

Background:

MTX is the first line treatment in early RA. There is robust evidence from cohort studies, but less from RCTs, that a “window of opportunity” exists over 12-16 weeks symptom duration. CR6086 is a selective prostaglandin EP4 receptor antagonist, with an immunomodulatory profile.

Objectives:

To test efficacy and safety of CR6086 added to MTX in early RA, DMARD-naïve patients.

Methods:

Patients with RA (ACR/EULAR 2010 criteria), < 1 year from symptom onset and naïve to DMARDs were randomized to oral CR6086 30, 90, 180mg, or placebo bid and oral MTX (20mg weekly) for 13 weeks (NCT03163966). Primary endpoint was the ACR20 response rate: 240 patients were needed to detect a difference among groups, with 50% responders on placebo and 70% on the 90mg CR6086 target dose. Pairwise comparisons of proportions were performed, with nonresponder imputation for withdrawals. A subgroup of patients underwent dynamic contrast-enhanced (DCE) MRI for quantification of synovitis at MCP and wrist joints, evaluated as DEMRIQ-ME and DEMRIQ-vol.

Results:

The ITT population included all 244 randomized patients receiving at least one dose of study drugs (59 CR6086 30mg/MTX, 60 CR6086 90mg/MTX, 63 CR6086 180mg/MTX, 62 placebo/MTX). Safety was good with no increased rate of infections or other disorders; however, there were more minor upper GI adverse events (AEs) with CR6086, and increased dropouts due to AEs with the 180mg dose (9/63, 14.3% vs 1.7-3.4% in other groups). There were more ACR20 responders with MTX monotherapy than predicted (59.7%) and thus the 10.3% difference with the 90mg target dose (70.0%) was not significant. The low 30mg dose was no better than placebo (55.9%), while the high 180mg dose did not provide additional benefit compared with 90mg (74.0% net of dropouts). CR6086 90mg and 180mg induced a significant improvement in MRI, compared with placebo (Fig. 1). In a post-hoc analysis in patients < 6 months from symptom onset (ACR definition of early RA: 98/244, 40.2%), MTX monotherapy exerted a large 76% ACR20 response rate that precluded potentiation. Conversely, in patients of 6-12 months disease duration (146/244, 59.8%) ACR20 responders were 48.6% with MTX monotherapy vs 68.4% with 90mg, i.e. a 19.8% difference as postulated, with proportional differences in secondary endpoints (Tab. 1).

Conclusion:

There was no benefit demonstrated for CR6086 added to MTX in the study cohort as a whole. However, in a post-hoc analysis, enhanced responses were observed with CR6086 90mg bid added to MTX in patients >6 months disease duration. This generated the hypothesis that addition of CR6086 90mg bid may benefit in RA patients initiating MTX after the window of opportunity, to be tested in further studies.

Table 1.

Patient characteristics & pregnancy outcomes

Symptom onset <12 months(principal analysis)Symptom onset 6-12 months(post-hoc analysis)*Placebo+MTX(N=62)CR6086 90mg+MTX(N=60)Placebo+MTX(N=37)CR6086 90mg+MTX(N=38)ACR20, %59.7%70.0%48.6%68.4%ACR50, %33.9%38.3%29.7%39.5%ACR70, %17.7%23.3%10.8%28.9%DAS28 (CRP) <2.6, %12.9%20.0%8.1%18.4%CDAI ≤2.8, %8.1%11.7%5.4%15.8%SDAI ≤3.3, %6.5%10.0%2.7%15.8%Boolean-based remission, %6.5%6.7%2.7%10.5%

*In patients with symptom onset <6 months, MTX monotherapy exerted a large 76% ACR20 response, and correspondingly high secondary efficacy parameters, precluding potentiation in this subset

Figure 1.

Change in MRI (DEMRIQ-ME#) after 13 weeks

Disclosure of Interests:

Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Ivanova Delina2 Delina: None declared, Minodora Mazur: None declared, Massimo D’Amato Employee of: Rottapharm Biotech, GIAMPAOLO GIACOVELLI Employee of: Rottapharm Biotech, Federica Girolami Employee of: Rottapharm Biotech, Marek Krogulec: None declared, René Østgård: None declared, Asger Reinstrup Bihlet Shareholder of: Nordic Bioscience A/S., Olga Kubassova Shareholder of: IAG, Image Analysis Group, Consultant of: Novartis, Takeda, Lilly, Employee of: IAG, Image Analysis Group, Lucio Rovati Shareholder of: Rottapharm Biotech, Employee of: Rottapharm Biotech, Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB